| NPI | 1811188444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN TAYLOR President 228-762-9250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 125766) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2020-08-27 |